Pancreas-Transplant Outcome in Relation to Presence or Absence of End-Stage Renal Disease, Timing of Transplant, Surgical Technique, and Donor Source

The differences in pancreas-transplant outcome according to recipient status, surgical approach, and donor source are illustrated by an analysis of results at one institution with experience in several categories. From July 1978 to January 1988, 210 pancreas transplants were performed, and 67 grafts are still functioning, the longest for 9.7 yr. Since October 1984, a uniform immunosuppressive protocol has been used, antilymphocyte globulin, cyclosporin, azathioprine, and prednisone for induction and the last three drugs for maintaining antirejection therapy. During this period, 110 pancreas transplants were performed, 62 in nonuremic non-kidney transplants, 28 in recipients of a previous kidney, and 20 simultaneous with a kidney; 64 with bladder and 43 with enteric drainage; and 25 from related and 85 from cadaver donors. The overall patient survival rate at 1 yr was 91%, and there were no significant differences between the various categories. Graft survival rates, however, differed between the various categories created by combinations of the above variables. With bladder drainage, 1-yr function rates were 58% (n = 30), 47% (n = 15), and 77% (n = 19) in recipients of a pancreas transplant alone, a pancreas after a kidney, or a simultaneous pancreas-kidney transplant; with enteric drainage, 1-yr function rates were 33% (n = 32) and 36% (n = 11) in the pancreas transplant alone and pancreas after kidney categories (enteric drainage was not done in double-transplant patients). The worst results were in recipients of enteric-drained cadaverdonor grafts because of the high propensity for rejection episodes of grafts from this donor source and an inability to diagnose rejection episodes early with this surgical approach. The best results were in recipients of bladder-drained cadaver-donor and enteric- or bladder-drained related-donor grafts. These approaches are currently exclusively applied; bladder drainage allows for early diagnosis and treatment of rejection based on urinary amylase monitoring, which is very important for transplants from cadaver donors, in which the incidence of rejection episodes is much higher than for transplants from related donors. An analysis of the results of pancreas transplantation in patients who, since October 1984, have been transplanted by the approaches in current use, shows overall patient and graft survival rates at 1 yr of 91 and 57%, respectively. One-year graft function rates within the various categories were 56% for 45 pancreas transplants alone, 45% for 22 pancreas transplants after a kidney, and 77% for 19 simultaneous pancreaskidney transplants. The results are best in uremic recipients of simultaneous pancreas-kidney transplants, but with quadruple immunosuppressive therapy, long-term function can also be achieved in more than half of recipients of pancreas transplants alone.